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Published on: May 23, 2021
High risk and low prevalence diseases: Acute mastoiditis
Rachel E Bridwell1, Alex Koyfman2, Brit Long3
1Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA.
Insights
Acute mastoiditis, a serious pediatric infection, requires prompt diagnosis and management. This review covers its presentation, diagnosis using CT scans, and treatment with antibiotics to prevent severe complications.
Area of Science:
- Otolaryngology
- Pediatric Emergency Medicine
- Infectious Diseases
Background:
- Acute mastoiditis is a severe infection of the mastoid air cells, primarily affecting children.
- It often arises secondary to otitis media and can lead to significant morbidity and mortality.
Purpose of the Study:
- To review the key aspects of acute mastoiditis relevant to emergency department (ED) clinicians.
- To highlight diagnostic and management strategies based on current evidence.
Main Methods:
- Review of current evidence on the presentation, diagnosis, and management of acute mastoiditis.
- Emphasis on clinical examination findings and imaging modalities.
Main Results:
- Common symptoms include fever, malaise, and specific physical exam findings like postauricular erythema and mastoid tenderness.
- Computed tomography (CT) with contrast is crucial for diagnosis when uncertain and for identifying complications.
- Treatment involves antibiotics and otolaryngology consultation.
Conclusions:
- Early recognition and appropriate management of acute mastoiditis are critical in the ED setting.
- Understanding potential complications such as abscesses and neurological involvement is essential for effective patient care.
Introduction:
Acute mastoiditis is a serious condition that carries with it a high rate of morbidity and mortality.
Objective:
This review highlights the pearls and pitfalls of mastoiditis, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
Discussion:
Acute mastoiditis most commonly affects pediatric patients and is a suppurative infection of the mastoid air cells. It is often associated with otitis media, and common bacteria include Streptococcus and Staphylococcus. History and examination may reveal tympanic membrane erythema, pinna protrusion, postauricular erythema, mastoid tenderness with palpation, external canal swelling, otorrhea, fever, and malaise. The disease should be suspected in those who fail treatment for otitis media and those who demonstrate the aforementioned abnormalities on examination and systemic symptoms. Laboratory analysis may reveal evidence of systemic inflammation, but a normal white blood cell count and other inflammatory markers should not be used to exclude the diagnosis. Computed tomography (CT) of the temporal bones with intravenous contrast is the recommended imaging modality if the clinician is unsure of the diagnosis. CT may also demonstrate complications. Treatment includes antibiotics such as ampicillin-sulbactam or ceftriaxone as well as otolaryngology consultation. Complications may include subperiosteal and intracranial abscess, deep neck abscess, facial nerve palsy, meningitis/encephalitis, venous sinus thrombosis, and seizures.
Conclusions:
An understanding of acute mastoiditis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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